Spoon FeedKnow the laws in your state, hospital policy, and recent Supreme Court decision that governs your responsibility in working with law enforcement to obtain evidence from patients.

Why does this matter?The relationship between law enforcement and those of us in healthcare may raise important ethical issues of consent, assault, and authority. It is best to think these over ahead of time.

Nurse ArrestedNormally, law enforcement and healthcare work well together. I am so grateful for their armed presence in our department. However, at times clashes may occur, as in the recent viral video of a nurse assaulted by a detective for standing her ground. This op-ed in the NEJM addressed this standoff. In an awake patient giving consent, an officer's request for a blood draw is reasonable. It is also unequivocal if the officer has a warrant. But in patients unable to consent (comatose, etc.), the situation is more difficult. The situation in Utah was extraordinary because the nurse, Alex Wubbels, was simply complying with a policy that her hospital and Salt Lake City police had previously agreed to follow. She was factual and professional that she was not allowed to do the blood test on this unconscious patient who was unable to consent, yet the officer became very angry and was anything but professional. In fact, he roughly put her in handcuffs and arrested her. When to take an ethical stand against an armed officer is challenging to say the least. The editorialist noted, "Alex Wubbels is an exemplar of the clinician who, in the face of extreme pressure to do otherwise, adhered to her professional ethical principles."

The article referenced the recent Supreme Court decision Birchfield vs. North Dakota from 2015 to address this topic. The Justices determined, on the basis of the 4th Amendment (proscribing unreasonable search or seizure of property), that a person could refuse a blood alcohol test and face a civil penalty (revocation of driver's license) but not a criminal penalty. However, a breath test for alcohol content was not considered a violation of the 4th Amendment and was deemed permissible without a warrant for an officer to perform, in view of making an arrest for suspicion of driving while intoxicated. Again, if a patient consents to a blood alcohol test, one may be drawn. Also, if an officer has a legal warrant for the blood test, one may be drawn. Many thanks to Thomas, who read this Supreme Court decision and pointed out the salient points to me.